Health effects of climate change will affect billions | Lancet Report

Lancet and University College London Institute for Global Health Commission

Managing the health effects of climate change

Executive summary | Climate change is the biggest global health threat of the 21st century

Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, earth’s average surface temperature rises are likely to exceed the safe threshold of 2°C above preindustrial average temperature. Rises will be greater at higher latitudes, with medium-risk scenarios predicting 2–3°C rises by 2090 and 4–5°C rises in northern Canada, Greenland, and Siberia. In this report, we have outlined the major threats—both direct and indirect—to global health from climate change through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration. Although vector-borne diseases will expand their reach and death tolls, especially among elderly people, will increase because of heatwaves, the indirect effects of climate change on water, food security, and extreme climatic events are likely to have the biggest effect on global health.

A new advocacy and public health movement is needed urgently to bring together governments, international agencies, non-governmental organisations (NGOs), com-munities, and academics from all disciplines to adapt to the effects of climate change on health. Any adaptation should sit alongside the need for primary mitigation: reduction in greenhouse gas emissions, and the need to increase carbon biosequestration through reforestation and improved agricultural practices. The recognition by governments and electorates that climate change has enormous health implications should assist the advocacy and political change needed to tackle both mitigation and adaptation.

Management of the health effects of climate change will require inputs from all sectors of government and civil society, collaboration between many academic disciplines, and new ways of international cooperation that have hitherto eluded us. Involvement of local communities in monitoring, discussing, advocating, and assisting with the process of adaptation will be crucial. An integrated and multidisciplinary approach to reduce the adverse health effects of climate change requires at least three levels of action. First, policies must be adopted to reduce carbon emissions and to increase carbon biosequestration, and thereby slow down global warming and eventually stabilise temperatures. Second, action should be taken on the events linking climate change to disease. Third, appropriate public health systems should be put into place to deal with adverse outcomes.

While we must resolve the key issue of reliance on fossil fuels, we should acknowledge their contribution to huge improvements in global health and development over the past 100 years. In the industrialised world and richer parts of the developing world, fossil fuel energy has contributed to a doubled longevity, dramatically reduced poverty, and increased education and security for most populations.

Conclusions and recommendations

This report raises many challenging and urgent questions for politicians, civil servants, academics, health professionals, NGOs, pressure groups, and local communities. Climate change is potentially the biggest global health threat in the 21st century. Our response requires a new public health movement that is multidisciplinary and multisectoral, and that leads to coordinated thinking and action across governments, international agencies, NGOs, and academic institutions. Any adaptation interventions must sit alongside the need for primary mitigation: reduction in greenhouse gas emissions. Indeed, recognition by governments and electorates that climate change has enormous health implications should assist the advocacy and political change to tackle mitigation and adaptation.

Whichever mitigation strategies are chosen by governments or agreed at the Copenhagen conference, the move to a low-carbon economy will have global health benefits and these must also be emphasised. More research is needed on win-win solutions, which are equally important in developed and developing countries.

We have proposed a framework for responding to the health effects through adaptation strategies, which in turn embeds mitigation strategies to improve human health worldwide.

This framework raises several important issues for action:

• Climate change mitigation and adaptation are essential elements to overall development policy. They are not separate issues that can be divided from the agenda for poverty alleviation or for closing the gap on social inequalities and health.

• The most urgent need is to empower poor countries, and local government and local communities everywhere, to understand climate implications and to take action. Health professionals and university academics have an important catalytic role. Multi-disciplinary groups from higher education institutions can have a forceful role in engaging with community leaders, civil society organisations, and students in these debates. There is a need for new financing for global links between developed and developing countries that create a two-way dialogue. Developed countries can help to strengthen capacity for high-quality research and information collection in developing countries, and developing countries can strengthen the ability of developed countries to understand sustainability and low-carbon living. Empowerment is as much about community mobilisation as high-level political action. The empowerment process is likely to be pluralistic and chaotic, but health and academic communities can do much to support and catalyse these processes.

• An agenda for developing countries must be developed through global cooperation. Representation on global task forces to assess the health effect of climate change is heavily skewed in favour of institutions in developed countries. In poor countries, health assessments and high-level climate science and health surveillance research are a priority. New research and advocacy groupings in Africa and south Asia are needed, and the academic community of developed countries must have a role in lobbying for resources and support. Food and water insecurity are early effects of climate change and will be a high priority for poor communities. Distilling academic findings into simple language, policy briefs, and user-friendly media is essential.

• Climate change should be integrated into the entire discourse of our present and should be taken into consideration for all governance actions. An advocacy movement must ensure that the health effects of climate change are placed high on the agenda of every research and development funder, philanthropist, academic journal, scientific conference, professional meeting, and university or school curriculum. Academics should lead advocacy within their own spheres of influence.

• Accountability mechanisms are crucial. We hope that this report will initiate or stimulate new funding and networks to monitor what is happening in government, civil society, academia, local government, and communities, especially in the most vulnerable populations. Accountability indicators should be monitored by the academic community and civil society organisations. It should be possible to agree upon health and climate change goals and targets for the processes of engagement and empowerment. Global and regional conferences and working groups to develop these outputs would be valuable in the same way that previous reports published in The Lancet have stimulated action on child survival, nutrition, and maternal health through the countdown to 2015. A biennial review of progress towards agreed targets would help to accelerate progress through celebration of success and identification of areas where progress is lagging.

• Awareness of health risks can have an important role in strengthening carbon mitigation debates and targets. Joint statements from national institutes of medicine, representative bodies such as royal colleges, journal editors, organisations such as the Climate and Health Council,175 and university leaders worldwide, drawing upon a growing evidence base, can create a solidarity and authority that politicians will find hard to resist. The priority is to send clear messages to the Copenhagen conference in December,

http://www.thelancet.comVol 373 May 16, 2009 1729 2009, emphasising the health consequences of climate change, even with a 2°C increase in temperatures (which is now broadly accepted as inevitable), with estimates of the severity of health effects at warming up to 4°C. Public and policy maker recognition of the profound meaning of the existence of threats from climate change to nature’s life processes, to the productive and stabilising ecosystems upon which we depend, and hence to human health and survival, will have great effect on the seriousness and urgency with which we approach this unprecedented challenge.

• The frequently observed state of fragmented health systems, with little attention paid to long-term sustainability, must give way to the development of coherent, population-based, and bottom-up health planning. Health systems must not act only as a platform for the delivery of clinical services but also provide the foundation for an effective public health response to the many climate-induced threats to health. This action will require more attention being paid to the organisational and management deficiencies of ministries of health, including subnational health governance and management structures. Long-term strategies and investments will be needed to develop the clinical and management human capacity of health systems. Some countries will also need to address the currently unregulated and disorganised private sector to harness existing resources to better serve the public interest. Many countries currently lack any coherent long-term and sustainable development agenda for their health systems. This needs to change.

• The move to a low-carbon economy will have global health benefits from both a reduction in the health effects of climate change and improvement in human lifestyles, and these must be emphasised. There must be more research on win-win solutions, which are equally important in rich and poor countries. For example building new green cities in the developed world, which minimise the need for cars and maximise exercise, will contribute to the fight against obesity. In poorer countries, developing water and energy systems, which are operated by local renewable sources of power, cuts reliance on imported fossil fuels and empowers local community groups.

• Building low-carbon and climate-resilient cities in emerging economies that adapt to continuing rural–urban migration, driven both by economic development and climate effects, is important. More than a third of the world’s population now live in urban areas in low-income or middle-income nations. Even Africa has 40% of its population in urban areas, a number that is larger than that in North America. Worldwide, the numbers of people injured or killed by storms and floods, and the amount of economic damage caused and insurance claims made, especially in these urban areas, have increased.

• Three priorities for action in urban areas are to improve the capacity and accountability of local and municipal government, to change their relation to informal settlers, and to ensure that government policies encourage rather than hinder the con-tributions to adaptation made by individuals, community organisations, and private enterprise.70 Urban developments could use climate-resilient engineering on sites at low risk of water or food stress, and provide sustainable low-carbon transport and other infrastructure. A new approach to urban planning to ensure healthy food supplies, adequate exercise, clean air, clean water, devolved health service structures, and education might provide a model of what we mean by a climate-adapted public health response.

High-income countries have caused almost all the anthropogenic climate change that has occurred to date, and they must now face extremely challenging political and economic choices if climate change mitigation is to be achieved. The UCL Lancet Commission has recognised Antonio Gramsci’s pessimism of the intellect and optimism of the will in tackling this issue. The academic community has a crucial role in facing up to the challenge of climate change, the health consequences we shall bequeath to our children and grandchildren (panel 7), and in helping to inform and support a policy process that will challenge us all.

What is a practical way to take the challenge forward? We call for a collation of global expertise on the health effects of climate change leading up to a major conference within the next 2 years, which will define the priorities for management, implementation, and monitoring. Representation from developing countries should be emphasised. The conference should bring representatives of all interested groups together to share experiences, and to discuss and endorse a set of key indicators and targets (climate and health adaptation goals developed by an international expert working group) for concerted global action. A key element of this action programme should focus on ways in which the poor nations can develop their own capacity to monitor problems, and to improve the evidence base for policy makers and planners. We believe a biennial review of progress towards agreed targets would help to accelerate progress through celebration of success and identification of areas in which progress is lagging.